Competencies for NHS Health Check Enhanced Service using the General Level Framework & Service Specification This is a comprehensive mapping of the GLF against the enhanced service specification (where this exists) and the use of PGDs where applicable. The mapping interprets the key GLF behaviours for the enhanced service. The HAG competencies are also listed against the relevant behavioural statements of the GLF. Pharmacists should use this mapping to support and identify portfolio entries for CPD. A quick reference guide showing where the HAG competencies specifically map to the GLF behaviours is also available at www.codeg.org and http://www.pharmacyworkforcenw.nhs.uk/?page=115. This excludes the interpretation of the behaviours against the service specification. The following documents were used to produce this mapping: 1. EN15. NHS Community Pharmacy Contractual Framework Enhanced Service NHS Health Check (Vascular risk assessment and management service) June 2009 2. Harmonisation of Accreditation Group (HAG) Competencies and Training Framework: Provision of an NHS Heath Check Service Version 1 April 2010 3. Skills for Health Vascular Risk Assessment: Workforce Competences April 2009 Delivery of Patient Care Cluster Interpretation for NHS Health Check Enhanced Service (using national service spec 1 ) Link to HAG Competencies for NHS Health Check Enhanced Service 2 Examples of Evidence for a Portfolio Patient Assessment Uses appropriate questioning to obtain relevant information from the patient 1.1 The pharmacy will provide a vascular risk assessment and management service for people in the target group (people aged 40 to 74 years of age who have not had a previous diagnosis of vascular disease) in order to improve the person s awareness of their vascular risk and how to minimise or manage that risk. The service will comply with the DH national requirements, in order that NHS Health Checks are delivered in a uniform, systematic and integrated manner. 3.5 Consenting people will have the following parameters measured and / or recorded: 2. Has knowledge of vascular risk and the background to cardiovascular disease. 3. Able to identify and recruit appropriate clients for NHS Health Checks. 6. Able to assess an individual s risk of developing cardiovascular Witness statement or case example. Patient feedback /audit of the Health Check service. Performance record from informal/formal training role play/osce. - 1 -
Consultation or referral Pharmaceutical or health problems are appropriately referred Age; Gender; Smoking status; Level of physical activity; Family history of vascular disease; Ethnicity; Body Mass Index; Random blood cholesterol measurement (Total and HDL cholesterol); and Blood pressure. A diabetes filter, based on BMI and blood pressure measurement, will be used to determine whether the person should undergo a fasting blood glucose or HbA1c measurement. 3.7 Vascular risk will be assessed using the locally agreed risk assessment engine, e.g. Framingham or QRISK 2. 3.8 In line with NHS Health Check: Vascular Risk Assessment and Management Best Practice Guidance people who have a BMI greater than 30 (27.5 or over in individuals from Indian, Pakistani, Bangladeshi, Other Asian and Chinese ethnicity categories) or blood pressure that is at or greater than 140/90 mmhg will need to have an assessment of their blood glucose. Commissioners will determine whether this assessment uses a measurement of fasting blood glucose or HbA1c (fasting not required). Where a high fasting blood glucose or HbA1c result is found the person will be referred to their GP or a professional with suitable patient information and prescribing responsibilities for further investigation. 1.4 People who are found to be at moderate or high risk will be offered appropriate interventions and referral, where required, in line with national and local guidance. 1.5 Where pre-existing disease is suspected or identified the person will be referred to their GP. 3.8 In line with NHS Health Check: Vascular Risk Assessment and Management Best Practice disease (CVD) using appropriate evidence based tool (to be defined) and methodologies, including weight, height, cholesterol, blood glucose and blood pressure readings, knowing the limitations of the results. 7. Able to communicate with clients appropriately and sensitively, understanding patient confidentiality issues. 10. Aware of other related services and knows how and when to refer / sign post clients regarding further support and advice. 11. Able to communicate effectively with local healthcare professionals as part of the referral pathway, understanding how and Completion of HAG workshop or similar assessments. Critical Incident e.g. where information was later identified that could have been elicited earlier. Completion of CPPE open learning programme Vascular risk focal point. Completion of CPPE open learning programme Screening populations, monitoring people, examining patients. Completion of CPPE open learning programme Coronary heart disease; evidence based management of. Case Example where referral to local services took place. List of relevant local services. Completion of HAG workshop or similar - 2 -
Guidance people who have a BMI greater than 30 (27.5 or over in individuals from Indian, Pakistani, Bangladeshi, Other Asian and Chinese ethnicity categories) or blood pressure that is at or greater than 140/90 mmhg will need to have an assessment of their blood glucose. Commissioners will determine whether this assessment uses a measurement of fasting blood glucose or HbA1c (fasting not required). Where a high fasting blood glucose or HbA1c result is found the person will be referred to their GP or a professional with suitable patient information and prescribing responsibilities for further investigation. 3.9 In line with NHS Health Check: Vascular Risk Assessment and Management Best Practice Guidance people will be referred to their GP or a professional with suitable patient information and prescribing responsibilities where their blood pressure is at or greater than 140/90 mmhg in order that an assessment of hypertension and chronic kidney disease can be carried out. 3.10 The level of risk (high, moderate, low) will be communicated to the person, and an individually tailored management programme, with appropriate advice, support and interventions depending on the level of risk identified, will be agreed: The pharmacy will offer brief healthy lifestyle advice and support to all people receiving the service to assist them with managing and / or reducing their risk. People who are found to be at moderate risk will be offered, where appropriate, interventions such as stop smoking or weight management where the pharmacy has been commissioned to provide such a service. Where the pharmacy does not provide such services they will refer people to other service providers. People who are found to be at high risk will be offered, where appropriate, interventions such as stop smoking or weight management where the pharmacy has been commissioned to provide such a service. Where the pharmacy does not provide such services they will refer people to other service providers. All people found to be at high risk will also be referred on to their GP for further investigation and management. In many cases these when to ask for support and advice. assessments. Examples of completed paperwork/patient records related to scheme. Audit of the service to elicit the number of appropriate referrals to other services - 3 -
people will require pharmacological interventions and / or an intensive lifestyle programme for Impaired Glucose Tolerance/non-diabetic hyperglycaemia. Pharmacists trained as independent or supplementary prescribers may be able to manage this group of people. Where pre-existing disease is suspected or identified the person will be referred to their GP. The pharmacist will actively involve the person in agreeing what advice and/or interventions they will follow. Any decisions must be made in partnership with the person and with their informed consent. Recording Consultations Documents consultation where appropriate in the patient s records 3.20 Locally agreed referral criteria to GPs/specialist services will be in place and will be followed. The results of individual assessments will be sent to the person s GP using a locally agreed method specified by the PCT. 1.2 The results of the risk assessment will be communicated to the person and will be added to the person s pharmacy record and shared with their GP. 3.5 Consenting people will have the following parameters measured and / or recorded: Age; Gender; Smoking status; Level of physical activity; Family history of vascular disease; Ethnicity; Body Mass Index; Random blood cholesterol measurement (Total and HDL cholesterol); and Blood pressure. A diabetes filter, based on BMI and blood pressure measurement, will be used to determine whether the person should undergo a fasting blood glucose or HbA1c measurement. CVD EF3 Carry out assessment with individuals at risk of developing Cardiovascular Disease 3 : K3. How information obtained from individuals should be recorded and stored. CHS131 Obtain and test capillary blood samples 3 : K32 A working knowledge of how to record test results, and the importance of clear and accurate documentation. CHS19 Undertake physiological measurements 3 : Copy of an example of a record (anonymised). 3.21 The pharmacy contractor must maintain appropriate records, including the national minimum data set, to ensure effective ongoing service delivery and audit. Records will be confidential and must be K28 A working understanding of the importance of recording all information clearly and precisely in - 4 -
Patient consent Satisfactorily obtains patient consent if appropriate Relevant Patient Background Retrieval of ALL relevant and available information Drug History Documents an accurate and comprehensive drug history when required stored securely and for a length of time in line with NHS record retention policies. Local paperwork approved by the PCT will be used for the recording of relevant service information for the purposes of audit and the claiming of payment. 3.4 The pharmacy will ensure that people presenting for an NHS Health Check are informed about the process of the service and given the opportunity to ask questions. People will be asked to agree to the assessment and the communication of results to their GP. This agreement will be captured in writing. 3.10 [excerpt] The pharmacist will actively involve the person in agreeing what advice and/or interventions they will follow. Any decisions must be made in partnership with the person and with their informed consent. 3.5 Consenting people will have the following parameters measured and / or recorded: Age; Gender; Smoking status; Level of physical activity; Family history of vascular disease; Ethnicity; Body Mass Index; Random blood cholesterol measurement (Total and HDL cholesterol); and Blood pressure. A diabetes filter, based on BMI and blood pressure measurement, will be used to determine whether the person should undergo a fasting blood glucose or HbA1c measurement. Although not covered in the NHS Health Check Enhanced Service national service specification 1, taking a drug history is an important part of the assessment process because of the impact it may have on the outcome of the service. Local exclusion criteria may apply. the relevant documentation. 3. Able to identify and recruit appropriate clients for NHS Health Checks. 4. Appreciates the importance of taking into account an individual s need for privacy, dignity and choice when agreeing to and assessing their vascular risk. 7. Able to communicate with clients appropriately and sensitively, understanding patient confidentiality issues. 3. Able to identify and recruit appropriate clients for NHS Health Checks. 7. Able to communicate with clients appropriately and sensitively, understanding patient confidentiality issues. Service documentation showing consent. Case example where consent was problematic. Performance record from informal/formal training role play/osce. Completion of HAG workshop or similar assessments. Case example. Performance record from informal/formal training role play/osce. Completion of HAG workshop or similar assessments. Case example. Performance record from informal/formal training role play/osce. - 5 -
Completion of HAG workshop or similar assessments. Public Health Provides lifestyle advice appropriately 1.3 The pharmacy will offer brief healthy lifestyle advice and support to all people receiving the service to assist them with managing and / or reducing their risk. 2. Hasknowledge of vascular risk and the background to cardiovascular disease. Copies of leaflets available or given to clients. 3.2 Commissioners will determine which aspects of the NHS Health Check service they wish community pharmacies to provide. For example pharmacies could provide the risk assessment alone or they may additionally provide some aspects of risk management e.g. stop smoking or weight management support. 3.10 The level of risk (high, moderate, low) will be communicated to the person, and an individually tailored management programme, with appropriate advice, support and interventions depending on the level of risk identified, will be agreed: The pharmacy will offer brief healthy lifestyle advice and support to all people receiving the service to assist them with managing and / or reducing their risk. People who are found to be at moderate risk will be offered, where appropriate, interventions such as stop smoking or weight management where the pharmacy has been commissioned to provide such a service. Where the pharmacy does not provide such services they will refer people to other service providers. People who are found to be at high risk will be offered, where appropriate, interventions such as stop smoking or weight management where the pharmacy has been commissioned to provide such a service. Where the pharmacy does not provide such services they will refer people to other service providers. All people found to be at high risk will also be referred on to their GP for further investigation and management. In many cases these people will require pharmacological interventions and / or an intensive lifestyle programme for Impaired Glucose Tolerance/non-diabetic hyperglycaemia. Pharmacists trained as independent or supplementary prescribers may be able to manage this group of people. 7. Able to communicate with clients appropriately and sensitively, understanding patient confidentiality issues. 8. Able to deliver brief advice to enable behavioural change and self-care including management options for both modifiable and non-modifiable risk factors following a NHS Health Check. 9. Able to counsel and advise on smoking cessation, diet and benefits of regular activity. Witness statement or case example. CPD example demonstrating update on knowledge in this area. Completion of CPPE open learning programme Vascular risk focal point. Completion of CPPE open learning programme Coronary heart disease; evidence based management of. Performance record from informal/formal training role play/osce. Completion of HAG workshop or similar. - 6 -
Where pre-existing disease is suspected or identified the person will be referred to their GP. The pharmacist will actively involve the person in agreeing what advice and/or interventions they will follow. Any decisions must be made in partnership with the person and with their informed consent. 3.23 The PCT will be responsible for the provision of healthy lifestyle advice leaflets, counselling aids and other promotional material to providers in order to ensure consistent messages are delivered to people accessing the service. Health Needs Takes into account the patient s individual circumstances 4.1 The pharmacy has appropriate PCT / DH provided healthy lifestyle advice leaflets and other promotional material available for the client group, actively promotes its uptake and is able to discuss the contents of the material with the client, where appropriate. 1.3 The pharmacy will offer brief healthy lifestyle advice and support to all people receiving the service to assist them with managing and / or reducing their risk. 3. Able to identify and recruit appropriate clients for NHS Health Checks. 8. Able to deliver brief advice to enable behavioural change and self-care including management options for both modifiable and non-modifiable risk factors following a NHS Health Check. Case example. Performance record from informal/formal training role play/osce. Completion of HAG workshop or similar assessments. 9. Able to counsel and advise on smoking cessation, diet and benefits of regular activity. Need for information is identified Patient need for information is 3.4 The pharmacy will ensure that people presenting for an NHS Health Check are informed about the process of the service and given the opportunity to ask questions. People will be asked to agree to the assessment and the communication of results to their GP. This 10. Aware of other related services and knows how and when to refer / sign post clients regarding further support and advice. 7. Able to communicate with clients appropriately and sensitively, understanding patient confidentiality issues. Case example. Copies of leaflets available or given to - 7 -
accurately identified agreement will be captured in writing. clients. Provision of written information Appropriate information is provided 4.1 The pharmacy has appropriate PCT / DH provided healthy lifestyle advice leaflets and other promotional material available for the client group, actively promotes its uptake and is able to discuss the contents of the material with the client, where appropriate. 1.3 The pharmacy will offer brief healthy lifestyle advice and support to all people receiving the service to assist them with managing and / or reducing their risk. 3.3 The information leaflet developed by the Department of Health should be provided to the person in advance of the NHS Health Check. The PCT will make these leaflets available to pharmacies providing the service. 3.4 The pharmacy will ensure that people presenting for an NHS Health Check are informed about the process of the service and given the opportunity to ask questions. People will be asked to agree to the assessment and the communication of results to their GP. This agreement will be captured in writing. 2. Hasknowledge of vascular risk and the background to cardiovascular disease. 7. Able to communicate with clients appropriately and sensitively, understanding patient confidentiality issues. Performance record from informal/formal training role play/osce. Completion of HAG workshop or similar assessments. Copies of leaflets available or given to clients. List of useful internet sites passed on to clients. List of local related services. 3.22 The PCT will coordinate any promotion of the service locally, including the development of publicity materials and the use of nationally produced materials. Pharmacies should use these materials to promote the service to the public in line with guidance from the PCT and should ensure they coordinate their promotional activities with those of the PCT. PCTs may wish to promote the service using the public health campaigns element of the community pharmacy contractual framework. 3.23 The PCT will be responsible for the provision of healthy lifestyle advice leaflets, counselling aids and other promotional material to providers in order to ensure consistent messages are delivered to people accessing the service. - 8 -
Use of Guidelines Current clinical guidelines are applied as appropriate Record of contributions Appropriate documentation of the intervention is completed 4.1 The pharmacy has appropriate PCT / DH provided healthy lifestyle advice leaflets and other promotional material available for the client group, actively promotes its uptake and is able to discuss the contents of the material with the client, where appropriate. 1.1 The pharmacy will provide a vascular risk assessment and management service for people in the target group (people aged 40 to 74 years of age who have not had a previous diagnosis of vascular disease) in order to improve the person s awareness of their vascular risk and how to minimise or manage that risk. The service will comply with the DH national requirements, in order that NHS Health Checks are delivered in a uniform, systematic and integrated manner. 1.4 People who are found to be at moderate or high risk will be offered appropriate interventions and referral, where required, in line with national and local guidance. 3.7 Vascular risk will be assessed using the locally agreed risk assessment engine, e.g. Framingham or QRISK 2. 3.15 Point of Care Testing (POCT) equipment used for the assessment of blood glucose, HbA1c and cholesterol levels will be procured after an assessment of the equipment options available at the time and after approval from the PCT. Guidance on procuring POCT equipment is contained in GH/016 Guidelines for point of care testing: haematology (British Committee for Standards in Haematology) and in MHRA guidance. 1.2 The results of the risk assessment will be communicated to the person and will be added to the person s pharmacy record and shared with their GP. 3.4 The pharmacy will ensure that people presenting for an NHS Health Check are informed about the process of the service and given the opportunity to ask questions. People will be asked to agree to the assessment and the communication of results to their GP. This agreement will be captured in writing. 3.5 Consenting people will have the following parameters measured and / or recorded: 1. Understands why vascular risk is part of health policy. 2. Has knowledge of vascular risk and the background to cardiovascular disease. 8. Able to deliver brief advice to enable behavioural change and self-care including management options for both modifiable and non-modifiable risk factors following a NHS Health Check. 9. Able to counsel and advise on smoking cessation, diet and benefits of regular activity. CHS131 Obtain and test capillary blood samples 3 : K32 A working knowledge of how to record test results, and the importance of clear and accurate documentation. CHS19 Undertake physiological measurements 3 : K28 A working understanding of Copy of Guideline (or executive summary) and local Service Specification that includes clinical information. Case example where guidance applied. Case example. Service proforma / examples of record keeping. - 9 -
Age; Gender; Smoking status; Level of physical activity; Family history of vascular disease; Ethnicity; Body Mass Index; Random blood cholesterol measurement (Total and HDL cholesterol); and Blood pressure. A diabetes filter, based on BMI and blood pressure measurement, will be used to determine whether the person should undergo a fasting blood glucose or HbA1c measurement. the importance of recording all information clearly and precisely in the relevant documentation. Assessing outcomes of contributions Outcomes of contributions are appropriately assessed 3.21 The pharmacy contractor must maintain appropriate records, including the national minimum data set, to ensure effective ongoing service delivery and audit. Records will be confidential and must be stored securely and for a length of time in line with NHS record retention policies. Local paperwork approved by the PCT will be used for the recording of relevant service information for the purposes of audit and the claiming of payment. 3.21 The pharmacy contractor must maintain appropriate records, including the national minimum data set, to ensure effective ongoing service delivery and audit. Records will be confidential and must be stored securely and for a length of time in line with NHS record retention policies. Local paperwork approved by the PCT will be used for the recording of relevant service information for the purposes of audit and the claiming of payment. 4.6 The pharmacy participates in an annual PCT organised audit of service provision. 4.7 The pharmacy co-operates with any local assessment of service user experience. Copy of information on service provision. - 10 -
Personal Competency Cluster Efficiency Uses time efficiently Interpretation for NHS Health Check Enhanced Service (using national service spec 1 ) Link to HAG Competencies for NHS Health Check Enhanced Service 2 3. Able to identify and recruit appropriate clients for NHS Health Checks. Examples of Evidence for a Portfolio Copy of appointment system process used (e.g. diary management staff protocol). Effective communication skills with (patient/carer, healthcare professionals, immediate pharmacy team, and linked organisations) Communication is clear, precise and appropriate Pharmacy Team Recognises value of other staff and works effectively as part of a team 3.4 The pharmacy will ensure that people presenting for an NHS Health Check are informed about the process of the service and given the opportunity to ask questions. People will be asked to agree to the assessment and the communication of results to their GP. This agreement will be captured in writing. 3.10 [excerpt] The pharmacist will actively involve the person in agreeing what advice and/or interventions they will follow. Any decisions must be made in partnership with the person and with their informed consent. 3.20 Locally agreed referral criteria to GPs/specialist services will be in place and will be followed. The results of individual assessments will be sent to the person s GP using a locally agreed method specified by the PCT. 7. Able to communicate with clients appropriately and sensitively, understanding patient confidentiality issues. 8. Able to deliver brief advice to enable behavioural change and self-care including management options for both modifiable and non-modifiable risk factors following a NHS Health Check. 9. Able to counsel and advise on smoking cessation, diet and benefits of regular activity. 11. Able to communicate effectively with local healthcare professionals as part of the referral pathway, understanding how and when to ask for support and advice. Completion of the service consultation form. Witness statements. Case example where communication was difficult. Case example of a referral. Performance record from informal/formal training role play/osce. Completion of HAG workshop or similar assessments. Completion of HAG workshop or similar assessments. Evidence of service review with whole team. - 11 -
Multi-disciplinary Team Recognises the value of other health professionals and uses appropriate channels for referral 1.2 The results of the risk assessment will be communicated to the person and will be added to the person s pharmacy record and shared with their GP. 1.5 Where pre-existing disease is suspected or identified the person will be referred to their GP. 3.8 In line with NHS Health Check: Vascular Risk Assessment and Management Best Practice Guidance people who have a BMI greater than 30 (27.5 or over in individuals from Indian, Pakistani, Bangladeshi, Other Asian and Chinese ethnicity categories) or blood pressure that is at or greater than 140/90 mmhg will need to have an assessment of their blood glucose. Commissioners will determine whether this assessment uses a measurement of fasting blood glucose or HbA1c (fasting not required). Where a high fasting blood glucose or HbA1c result is found the person will be referred to their GP or a professional with suitable patient information and prescribing responsibilities for further investigation. 10. Aware of other related services and knows how and when to refer / sign post clients regarding further support and advice. 11. Able to communicate effectively with local healthcare professionals as part of the referral pathway, understanding how and when to ask for support and advice. Knowledge of local Referral Pathways/services. Case example where referral was made. 3.9 In line with NHS Health Check: Vascular Risk Assessment and Management Best Practice Guidance people will be referred to their GP or a professional with suitable patient information and prescribing responsibilities where their blood pressure is at or greater than 140/90 mmhg in order that an assessment of hypertension and chronic kidney disease can be carried out. 3.10 The level of risk (high, moderate, low) will be communicated to the person, and an individually tailored management programme, with appropriate advice, support and interventions depending on the level of risk identified, will be agreed: The pharmacy will offer brief healthy lifestyle advice and support to all people receiving the service to assist them with managing and / or reducing their risk. People who are found to be at moderate risk will be offered, where appropriate, interventions such as stop smoking or weight management where the pharmacy has been commissioned to - 12 -
provide such a service. Where the pharmacy does not provide such services they will refer people to other service providers. People who are found to be at high risk will be offered, where appropriate, interventions such as stop smoking or weight management where the pharmacy has been commissioned to provide such a service. Where the pharmacy does not provide such services they will refer people to other service providers. All people found to be at high risk will also be referred on to their GP for further investigation and management. In many cases these people will require pharmacological interventions and / or an intensive lifestyle programme for Impaired Glucose Tolerance/non-diabetic hyperglycaemia. Pharmacists trained as independent or supplementary prescribers may be able to manage this group of people. Where pre-existing disease is suspected or identified the person will be referred to their GP. The pharmacist will actively involve the person in agreeing what advice and/or interventions they will follow. Any decisions must be made in partnership with the person and with their informed consent. Confidentiality Maintains confidentiality 3.20 Locally agreed referral criteria to GPs/specialist services will be in place and will be followed. The results of individual assessments will be sent to the person s GP using a locally agreed method specified by the PCT. 3.11 A consultation area, at least at the level required for the provision of the Medicines Use Review service, which provides sufficient privacy (including visual privacy) and safety, will be used for provision of the service. Hand washing facilities will be required within the consultation area or nearby. The pharmacy contractor must ensure that NHS infection control standards are complied with. 3.21 The pharmacy contractor must maintain appropriate records, including the national minimum data set, to ensure effective ongoing service delivery and audit. Records will be confidential and must be stored securely and for a length of time in line with NHS record retention policies. Local paperwork approved by the PCT will be used for the recording of relevant service information for the purposes of audit and the claiming of payment. 4. Appreciates the importance of taking into account an individual s need for privacy, dignity and choice when agreeing to and assessing their vascular risk. 7. Able to communicate with clients appropriately and sensitively, understanding patient confidentiality issues. Premises accreditation record. Critical Incident. E.g. of Service SOPs re record keeping / confidentiality for staff involved with service. - 13 -
Recognition of Limitation Recognises limitations 1.4 People who are found to be at moderate or high risk will be offered appropriate interventions and referral, where required, in line with national and local guidance. 2. Has knowledge of vascular risk and the background to cardiovascular disease. Example of when advice was sought from a colleague. 6. Able to assess an individual s risk of developing cardiovascular disease (CVD) using appropriate evidence based tool (to be defined) and methodologies, including weight, height, cholesterol, blood glucose and blood pressure readings, knowing the limitations of the results. 11. Able to communicate effectively with local healthcare professionals as part of the referral pathway, understanding how and when to ask for support and advice. Performance record from informal/formal training role play/osce. Completion of HAG workshop or similar assessments. Example of CPD where performance gap identified. Quality and Accuracy of documentation Legally required info is documented 1.2 The results of the risk assessment will be communicated to the person and will be added to the person s pharmacy record and shared with their GP. 3.4 The pharmacy will ensure that people presenting for an NHS Health Check are informed about the process of the service and given the opportunity to ask questions. People will be asked to agree to the assessment and the communication of results to their GP. This agreement will be captured in writing. 3.5 Consenting people will have the following parameters measured and / or recorded: Age; Gender; Smoking status; Level of physical activity; Family history of vascular disease; CHS131 Obtain and test capillary blood samples 3 : K1 A factual knowledge of the current European and National legislation, national guidelines, organisational policies and protocols in accordance with Clinical/Corporate Governance which affect your work practice in relation to obtaining and testing capillary blood samples. K2 A working knowledge of your responsibilities and accountability in relation to the current European Copy of a sample proforma. - 14 -
Ethnicity; Body Mass Index; Random blood cholesterol measurement (Total and HDL cholesterol); and Blood pressure. A diabetes filter, based on BMI and blood pressure measurement, will be used to determine whether the person should undergo a fasting blood glucose or HbA1c measurement. and National legislation, national guidelines and local policies and protocols and Clinical/Corporate Governance. 3.21 The pharmacy contractor must maintain appropriate records, including the national minimum data set, to ensure effective ongoing service delivery and audit. Records will be confidential and must be stored securely and for a length of time in line with NHS record retention policies. Local paperwork approved by the PCT will be used for the recording of relevant service information for the purposes of audit and the claiming of payment. Confidence Inspires confidence 4.6 The pharmacy participates in an annual PCT organised audit of service provision. 4.7 The pharmacy co-operates with any local assessment of service user experience. 4.8 The results of external quality assurance tests fall within the acceptable range. 2. Has knowledge of vascular risk and the background to cardiovascular disease. 7. Able to communicate with clients appropriately and sensitively, understanding patient confidentiality issues. Audit outcomes. Quality assurance results. Local assessment of service user experience survey. Responsibility for patient care Takes responsibility for patient care 3.17 The pharmacy contractor must nominate a named lead pharmacist to act as the clinical lead for the service in each pharmacy. 10. Aware of other related services and knows how and when to refer / sign post clients regarding further support and advice. Critical Incident. Case Example. CPD 4.4 The pharmacy can demonstrate that pharmacists and staff involved in the provision of the service have undertaken CPD relevant to this service on at least an annual basis. CPD record (i.e. plan and record entry relating to Health Checks). - 15 -
Problem Solving Cluster Accesses Information Able to access information from appropriate information sources Interpretation for NHS Health Check Enhanced Service (using national service spec 1 ) 3.21 The pharmacy contractor must maintain appropriate records, including the national minimum data set, to ensure effective ongoing service delivery and audit. Records will be confidential and must be stored securely and for a length of time in line with NHS record retention policies. Local paperwork approved by the PCT will be used for the recording of relevant service information for the purposes of audit and the claiming of payment. Link to HAG Competencies for NHS Health Check Enhanced Service 2 11. Able to communicate effectively with local healthcare professionals as part of the referral pathway, understanding how and when to ask for support and advice. Examples of Evidence for a Portfolio Case Example. Critical incident. 3.22 The PCT will coordinate any promotion of the service locally, including the development of publicity materials and the use of nationally produced materials. Pharmacies should use these materials to promote the service to the public in line with guidance from the PCT and should ensure they coordinate their promotional activities with those of the PCT. PCTs may wish to promote the service using the public health campaigns element of the community pharmacy contractual framework. 3.23 The PCT will be responsible for the provision of healthy lifestyle advice leaflets, counselling aids and other promotional material to providers in order to ensure consistent messages are delivered to people accessing the service. 4.1 The pharmacy has appropriate PCT / DH provided healthy lifestyle advice leaflets and other promotional material available for the client group, actively promotes its uptake and is able to discuss the contents of the material with the client, where appropriate. Summarises information Able to summarise key points from information gathered Up to date information Keeps information needed on a day to day basis up to date 1.2 The results of the risk assessment will be communicated to the person and will be added to the person s pharmacy record and shared with their GP. 3.21 The pharmacy contractor must maintain appropriate records, including the national minimum data set, to ensure effective ongoing service delivery and audit. Records will be confidential and must be stored securely and for a length of time in line with NHS record 7. Able to communicate with clients appropriately and sensitively, understanding patient confidentiality issues. 2. Has knowledge of vascular risk and the background to cardiovascular disease. Case Example. Critical incident. CPD record (i.e. plan and record entry relating to Health Checks). - 16 -
retention policies. Local paperwork approved by the PCT will be used for the recording of relevant service information for the purposes of audit and the claiming of payment. 3.22 The PCT will coordinate any promotion of the service locally, including the development of publicity materials and the use of nationally produced materials. Pharmacies should use these materials to promote the service to the public in line with guidance from the PCT and should ensure they coordinate their promotional activities with those of the PCT. PCTs may wish to promote the service using the public health campaigns element of the community pharmacy contractual framework. 8. Able to deliver brief advice to enable behavioural change and self-care. including management options for both modifiable and non-modifiable risk factors following a NHS Health Check. 3.23 The PCT will be responsible for the provision of healthy lifestyle advice leaflets, counselling aids and other promotional material to providers in order to ensure consistent messages are delivered to people accessing the service. Pathophysiology Knowledge of pathophysiology 4.1 The pharmacy has appropriate PCT / DH provided healthy lifestyle advice leaflets and other promotional material available for the client group, actively promotes its uptake and is able to discuss the contents of the material with the client, where appropriate. 1.4 People who are found to be at moderate or high risk will be offered appropriate interventions and referral, where required, in line with national and local guidance. 2. Has knowledge of vascular risk and the background to cardiovascular disease. CPD record (i.e. plan and record entry relating to Health Checks). 1.5 Where pre-existing disease is suspected or identified the person will be referred to their GP. 8. Able to deliver brief advice to enable behavioural change and self-care including management options for both modifiable and non-modifiable risk factors following a NHS Health Check. Completion of CPPE open learning programme Vascular risk focal point. Completion of CPPE open learning programme Coronary heart disease; evidence based management of. - 17 -
Evaluates information Able to evaluate information gathered 1.4 People who are found to be at moderate or high risk will be offered appropriate interventions and referral, where required, in line with national and local guidance. 1.5 Where pre-existing disease is suspected or identified the person will be referred to their GP. 3.7 Vascular risk will be assessed using the locally agreed risk assessment engine, e.g. Framingham or QRISK 2. 3. Able to identify and recruit appropriate clients for NHS Health Checks. 6. Able to assess an individual s risk of developing cardiovascular disease (CVD) using appropriate evidence based tool (to be defined) and methodologies, including weight, height, cholesterol, blood glucose and blood pressure readings, knowing the limitations of the results. Completion of CPPE open learning programme Vascular risk focal point. Completion of CPPE open learning programme Screening populations, monitoring people, examining patients. Completion of CPPE open learning programme Coronary heart disease; evidence based management of. Performance record from informal/formal training role play/osce. Completion of HAG workshop or similar assessments. Case Example. - 18 -
Logical Approach Demonstrates a logical process to problem solving 3.6 The following diagrams describe the risk assessment pathway and the diabetes filter: 6. Able to assess an individual s risk of developing cardiovascular disease (CVD) using appropriate evidence based tool (to be defined) and methodologies, including weight, height, cholesterol, blood glucose and blood pressure readings, knowing the limitations of the results. Case Example. - 19 -
Provides accurate information And Provides relevant information 1.2 The results of the risk assessment will be communicated to the person and will be added to the person s pharmacy record and shared with their GP. 1.3 The pharmacy will offer brief healthy lifestyle advice and support to all people receiving the service to assist them with managing and / or reducing their risk. 3.4 The pharmacy will ensure that people presenting for an NHS Health Check are informed about the process of the service and given the opportunity to ask questions. People will be asked to agree to the assessment and the communication of results to their GP. This agreement will be captured in writing. 2. Has knowledge of vascular risk and the background to cardiovascular disease. 6. Able to assess an individual s risk of developing cardiovascular disease (CVD) using appropriate evidence based tool (to be defined) and methodologies, including weight, height, cholesterol, blood glucose and blood pressure readings, knowing the limitations of the results. Case example. Examples of leaflets used. 3.10 The level of risk (high, moderate, low) will be communicated to the person, and an individually tailored management programme, with appropriate advice, support and interventions depending on the level of risk identified, will be agreed: The pharmacy will offer brief healthy lifestyle advice and support to all people receiving the service to assist them with managing and / or reducing their risk. People who are found to be at moderate risk will be offered, where appropriate, interventions such as stop smoking or weight management where the pharmacy has been commissioned to provide such a service. Where the pharmacy does not provide such services they will refer people to other service providers. People who are found to be at high risk will be offered, where appropriate, interventions such as stop smoking or weight management where the pharmacy has been commissioned to provide such a service. Where the pharmacy does not provide such services they will refer people to other service providers. All people found to be at high risk will also be referred on to their GP for further investigation and management. In many cases these people will require pharmacological interventions and / or an intensive lifestyle programme for Impaired Glucose Tolerance/non-diabetic hyperglycaemia. Pharmacists trained as independent or supplementary prescribers may be able to manage this group of people. 7. Able to communicate with clients appropriately and sensitively, understanding patient confidentiality issues. 8. Able to deliver brief advice to enable behavioural change and self-care including management options for both modifiable and non-modifiable risk. factors following a NHS Health Check. 9. Able to counsel and advise on smoking cessation, diet and benefits of regular activity. 10. Aware of other related services and knows how and when to refer / sign post clients regarding further support and advice. - 20 -
Where pre-existing disease is suspected or identified the person will be referred to their GP. The pharmacist will actively involve the person in agreeing what advice and/or interventions they will follow. Any decisions must be made in partnership with the person and with their informed consent. 3.20 Locally agreed referral criteria to GPs/specialist services will be in place and will be followed. The results of individual assessments will be sent to the person s GP using a locally agreed method specified by the PCT. 4.1 The pharmacy has appropriate PCT / DH provided healthy lifestyle advice leaflets and other promotional material available for the client group, actively promotes its uptake and is able to discuss the contents of the material with the client, where appropriate. Provides timely information Ensures resolution of problem Management and Organisation Cluster Clinical Governance Issues Demonstrates the application of clinical governance issues 3.4 The pharmacy will ensure that people presenting for an NHS Health Check are informed about the process of the service and given the opportunity to ask questions. People will be asked to agree to the assessment and the communication of results to their GP. This agreement will be captured in writing. Interpretation for NHS Health Check Enhanced Service (using national service spec 1 ) 3.12 A clinical waste disposal service will be required for each participating pharmacy. The pharmacy will allocate a safe place to store equipment required for the provision of the service and the resultant clinical waste. 3.13 The pharmacy contractor must ensure that their staff are made aware of the risk associated with the handling of clinical waste and the correct procedures to be used to minimise those risks. Standard Operating Procedures (SOPs) for needle stick injury and the handling of clinical waste (including dealing with spillages) must be in place. 10. Aware of other related services and knows how and when to refer / sign post clients regarding further support and advice. 10. Aware of other related services and knows how and when to refer / sign post clients regarding further support and advice. Link to HAG Competencies for NHS Health Check Enhanced Service 2 5. Able to perform all relevant tests accurately including taking fingerbased blood samples, measuring blood pressure, determining BMI. Understands all the associated health and safety issues and requirements for quality assurance. Case example. Case example. Examples of Evidence for a Portfolio Examples of clinical governance documentation. Completion of CPPE open learning programme Vascular risk focal point. Completion of CPPE - 21 -
Staff involved in blood collection must be offered immunisation for Hepatitis B and uptake should be monitored. 3.14 Appropriate protective equipment, including gloves, overalls and materials to deal with spillages, must be readily available close to the site where the service is provided and clinical waste is stored. open learning programme Screening populations, monitoring people, examining patients. 3.16 POCT equipment must be used, cleaned, calibrated and serviced as advised by the manufacturer. Appropriate protocols must be in place directing the use, cleaning, quality assurance (internal and external), calibration and servicing of POCT equipment and they must be followed. 3.17 The pharmacy contractor must nominate a named pharmacist to act as the clinical lead for the service in each pharmacy. 4.5 The pharmacy can demonstrate robust quality assurance for any processes or equipment used. Standard Operating Procedures Uses relevant and up to date procedures for practice 4.6 The pharmacy participates in an annual PCT organised audit of service provision. 3.13 The pharmacy contractor must ensure that their staff are made aware of the risk associated with the handling of clinical waste and the correct procedures to be used to minimise those risks. Standard Operating Procedures (SOPs) for needle stick injury and the handling of clinical waste (including dealing with spillages) must be in place. Staff involved in blood collection must be offered immunisation for Hepatitis B and uptake should be monitored. 3.16 POCT equipment must be used, cleaned, calibrated and serviced as advised by the manufacturer. Appropriate protocols must be in place directing the use, cleaning, quality assurance (internal and external), calibration and servicing of POCT equipment and they must be followed. 5. Able to perform all relevant tests accurately including taking fingerbased blood samples, measuring blood pressure, determining BMI. Understands all the associated health and safety issues and requirements for quality assurance. Examples of SOPs used for the service. Evidence of regular review of Service SOPs. Audit of results of CVD calculation risk. 3.19 The pharmacy contractor must have a standard operating procedure in place for this service that will specify which groups of staff can provide the individual elements of the service. The pharmacy - 22 -